Dialectical Behavior Therapy for Binge Eating and Bulimia by Debra L. Safer, Christy F. Telch, Eunice Y. Chen Page A
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having it close at hand also allows them to review the content of newly taught skills and facilitates their keeping track of the work sheets by storing them in one place.
The Pretreatment Stage
43
Introductions
The therapists begin by welcoming the clients to the treatment program and expressing enthusiasm about embarking on this experience together. During the pretreatment interview, each client entering group treatment will have met at least one of the two cotherapists but may not have not met the other. Each cotherapist should briefy introduce himself or herself by name, describe his or her background, and, as relevant, mention his or her position in the research project or clinic.
Therapists then ask clients to take 1–2 minutes to introduce themselves by frst name and give any personal information they may wish to share (e.g., inter— ests/hobbies, occupation, whether they have children and/or a spouse). Clients may also wish to comment on their hopes for entering treatment.
Commitment to Abstinence from Binge Eating (and Purging) The next strategies are crucial. The therapists’ goal is to build a groundswell of excitement in order to motivate clients and help them take the step to commit to abstinence from binge eating (and purging). Therapists should convey the message that abstinence from problem eating behaviors is absolutely essential if clients are to have a high quality of life. In addition, therapists should express the frm belief that this goal can be accomplished. Therapists are aiming, by the conclusion of this discussion, to have elicited a verbal commitment from each group member to stop binge eating (and purging).
The commitment strategies in DBT for BED or BN are the same as those in standard DBT (Linehan, 1993a; i.e., Evaluating Pros and Cons, Playing the Devil’s Advocate, Foot in the Door, Door in the Face, Connecting Present Commitments to Prior Commitments, Highlighting Freedom to Choose in the Absence of Alterna— tives, and Cheerleading). Defned briefy in Chapter 2, these are described in more detail as particularly relevant. As noted, just as in standard DBT, motivation is not viewed as an internal state or intrinsic quality of the client. Instead, therapists understand the necessary role of situational variables that, when present, increase the likelihood that clients will exhibit a desired behavior (i.e., be “motivated”). Therapists also keep in mind that eliciting commitment and agreement from a client is an ongoing task, requiring therapists to constantly gauge the client’s current level of commitment and to return to the motivation and commitment strategies as the client’s commitment waxes and wanes.
Evaluating Pros and Cons is recommended as an initial technique to “sell” the commitment to abstinence from binge eating (and purging). Therapists might begin by stating:
“It’s so good to have you all fnally here! We assume that you are in this room because you want to gain control over your eating behavior and stop binge eating [and purging]. We’re also assuming that you want to have a full and satisfying quality of life, one in which you enjoy your relationships, experience a sense of mastery, and feel very good about yourselves most of the time. Binge eating [and purging] is a problem because it interferes with feeling good about
44
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA
yourself and having the high quality of life you desire, right? Yet there are reasons why you turn to food. It has benefts. So let’s begin by making an hon— est list of the pros and cons of continuing to be a binge eater [and purger]. The point isn’t to stack the deck for one position or the other but to take the time to really look hard at the advantages and disadvantages for you of continuing this behavior. We’ll start with the pros. What is the pull to remain a binger [and purger]? There must be advantages.”
One cotherapist elicits the “pros” from group
The Pretreatment Stage
43
Introductions
The therapists begin by welcoming the clients to the treatment program and expressing enthusiasm about embarking on this experience together. During the pretreatment interview, each client entering group treatment will have met at least one of the two cotherapists but may not have not met the other. Each cotherapist should briefy introduce himself or herself by name, describe his or her background, and, as relevant, mention his or her position in the research project or clinic.
Therapists then ask clients to take 1–2 minutes to introduce themselves by frst name and give any personal information they may wish to share (e.g., inter— ests/hobbies, occupation, whether they have children and/or a spouse). Clients may also wish to comment on their hopes for entering treatment.
Commitment to Abstinence from Binge Eating (and Purging) The next strategies are crucial. The therapists’ goal is to build a groundswell of excitement in order to motivate clients and help them take the step to commit to abstinence from binge eating (and purging). Therapists should convey the message that abstinence from problem eating behaviors is absolutely essential if clients are to have a high quality of life. In addition, therapists should express the frm belief that this goal can be accomplished. Therapists are aiming, by the conclusion of this discussion, to have elicited a verbal commitment from each group member to stop binge eating (and purging).
The commitment strategies in DBT for BED or BN are the same as those in standard DBT (Linehan, 1993a; i.e., Evaluating Pros and Cons, Playing the Devil’s Advocate, Foot in the Door, Door in the Face, Connecting Present Commitments to Prior Commitments, Highlighting Freedom to Choose in the Absence of Alterna— tives, and Cheerleading). Defned briefy in Chapter 2, these are described in more detail as particularly relevant. As noted, just as in standard DBT, motivation is not viewed as an internal state or intrinsic quality of the client. Instead, therapists understand the necessary role of situational variables that, when present, increase the likelihood that clients will exhibit a desired behavior (i.e., be “motivated”). Therapists also keep in mind that eliciting commitment and agreement from a client is an ongoing task, requiring therapists to constantly gauge the client’s current level of commitment and to return to the motivation and commitment strategies as the client’s commitment waxes and wanes.
Evaluating Pros and Cons is recommended as an initial technique to “sell” the commitment to abstinence from binge eating (and purging). Therapists might begin by stating:
“It’s so good to have you all fnally here! We assume that you are in this room because you want to gain control over your eating behavior and stop binge eating [and purging]. We’re also assuming that you want to have a full and satisfying quality of life, one in which you enjoy your relationships, experience a sense of mastery, and feel very good about yourselves most of the time. Binge eating [and purging] is a problem because it interferes with feeling good about
44
DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA
yourself and having the high quality of life you desire, right? Yet there are reasons why you turn to food. It has benefts. So let’s begin by making an hon— est list of the pros and cons of continuing to be a binge eater [and purger]. The point isn’t to stack the deck for one position or the other but to take the time to really look hard at the advantages and disadvantages for you of continuing this behavior. We’ll start with the pros. What is the pull to remain a binger [and purger]? There must be advantages.”
One cotherapist elicits the “pros” from group
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